Progression after radical prostatectomy for men in their thirties compared to older men

OBJECTIVE To assess the biochemical outcome after radical prostatectomy (RP) specifically for men aged 30-39 years, as previous studies suggest that prostate cancer in young men might be more aggressive. PATIENTS AND METHODS From a large (15 899) database of RPs (1975-2007) we identified 42 men aged 30-39, 893 aged 40-49, 4085 aged 50-59, 3766 aged 60-69, and 182 men aged >= 70 years old. The clinical characteristics and treatment outcomes were compared between men aged 30-39 years and older men. RESULTS Among the men in their thirties, 81% had organ-confined disease in the RP specimen, vs 62% of men aged >= 40 years. At a mean follow-up of 5 years, there was biochemical progression in 4.8% of men in their thirties and 16.1% of men age >= 40 years (P = 0.055). The corresponding 5-year biochemical progression-free survival estimates were 95% for men in their thirties and 83% for men aged >= 40 years (P = 0.045). On multivariate analysis, increasing age was a significant independent predictor of biochemical progression. CONCLUSION Contrary to earlier reports, in the present study men in their thirties did not have more aggressive disease. Instead, they had more favourable pathological features and progression-free survival rates than their older counterparts. After controlling for other prognostic variables on multivariate analysis, being in the fourth decade was independently associated with a lower risk of biochemical progression. These results suggest that early aggressive treatment for these patients with a long life-expectancy is associated with favourable long-term biochemical outcomes.